Stephen A Klinge1, John P Fulkerson2. 1. Lahey Hospital and Medical Center, Burlington, Massachusetts, U.S.A.. Electronic address: steveklingemd@gmail.com. 2. Orthopedic Associates of Hartford, Farmington, Connecticut, U.S.A.; University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A.
Abstract
PURPOSE: To evaluate a minimum 15-year clinical and radiographic follow-up after anteromedial tibial tubercle transfer (anteromedialization [AMZ]) for lateral and/or distal patellar facet arthrosis. METHODS: Patients treated from 1996 to 2000 were contacted. The inclusion criteria were a minimum of 15 years' follow-up after AMZ for isolated persistent retropatellar pain related to lateral and/or distal patellar chondrosis. The exclusion criteria were clinical patellar instability, revision, and significant medial patellar facet or adjacent compartment chondrosis. The anatomic location(s) and severity of arthrosis, as well as the degree of lateral maltracking, were documented. Follow-up data included pain, activity level, and satisfaction. RESULTS: Of 23 patients, 15 met the inclusion criteria. All were women (17 knees) followed up for a mean of 17.1 years (range, 15.4-18.8 years). The mean age at surgery was 29.5 years. Satisfactory results were reported in 94% of knees (16 of 17), based simply on patients' subjective evaluation of the degree of success perceived. An important criterion of satisfaction was that these patients stated they would opt to undergo surgery again under the same circumstances. For 35% of knees, patients reported engaging in recreational activities, whereas for 18%, patients were minimally active. The average pain score (range, 0-10) for 75% was 2.1, and most of these patients showed grade I or II arthrosis. Post-AMZ symptomatic medial patellar subluxation was corrected successfully in 2 patients. Removal of hardware was performed in 59% of knees, and additional procedures were required in 41%. No cases of postoperative lateral patellar instability or conversion to knee arthroplasty occurred. CONCLUSIONS: Anteromedial tibial tubercle transfer without articular cartilage implantation is effective in patellofemoral joint preservation, ameliorating symptoms and facilitating active lifestyles for a minimum of 15 years to nearly 20 years in patients with lateral and/or distal patellofemoral arthrosis. For 94% of knees, patients would choose to undergo the procedure again under the same circumstances. Fifty-nine percent underwent screw removal, and 41% required additional procedures, mostly arthroscopic. No patients in this therapeutic case series underwent an arthroplasty procedure. LEVEL OF EVIDENCE: Level IV, therapeutic cases series.
PURPOSE: To evaluate a minimum 15-year clinical and radiographic follow-up after anteromedial tibial tubercle transfer (anteromedialization [AMZ]) for lateral and/or distal patellar facet arthrosis. METHODS:Patients treated from 1996 to 2000 were contacted. The inclusion criteria were a minimum of 15 years' follow-up after AMZ for isolated persistent retropatellar pain related to lateral and/or distal patellar chondrosis. The exclusion criteria were clinical patellar instability, revision, and significant medial patellar facet or adjacent compartment chondrosis. The anatomic location(s) and severity of arthrosis, as well as the degree of lateral maltracking, were documented. Follow-up data included pain, activity level, and satisfaction. RESULTS: Of 23 patients, 15 met the inclusion criteria. All were women (17 knees) followed up for a mean of 17.1 years (range, 15.4-18.8 years). The mean age at surgery was 29.5 years. Satisfactory results were reported in 94% of knees (16 of 17), based simply on patients' subjective evaluation of the degree of success perceived. An important criterion of satisfaction was that these patients stated they would opt to undergo surgery again under the same circumstances. For 35% of knees, patients reported engaging in recreational activities, whereas for 18%, patients were minimally active. The average pain score (range, 0-10) for 75% was 2.1, and most of these patients showed grade I or II arthrosis. Post-AMZ symptomatic medial patellar subluxation was corrected successfully in 2 patients. Removal of hardware was performed in 59% of knees, and additional procedures were required in 41%. No cases of postoperative lateral patellar instability or conversion to knee arthroplasty occurred. CONCLUSIONS: Anteromedial tibial tubercle transfer without articular cartilage implantation is effective in patellofemoral joint preservation, ameliorating symptoms and facilitating active lifestyles for a minimum of 15 years to nearly 20 years in patients with lateral and/or distal patellofemoral arthrosis. For 94% of knees, patients would choose to undergo the procedure again under the same circumstances. Fifty-nine percent underwent screw removal, and 41% required additional procedures, mostly arthroscopic. No patients in this therapeutic case series underwent an arthroplasty procedure. LEVEL OF EVIDENCE: Level IV, therapeutic cases series.
Authors: Central South University National Clinical Research Center For Geriatric Disorders Xiangya Hospital Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi Date: 2021-01-15